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This chapter outlines anesthetic considerations for face transplantation procedure based on the experience of two hospitals where the first face transplants in the United States took place as well as preliminary data from three international centers (personal communication). Careful examination of a patient's airway is critical since it dictates intraoperative airway management plan. The goals and principles of intraoperative fluid management in face transplantation are similar to any other long surgical procedure involving micro-vascular free flaps. Airway management in cases where the composite graft involves maxillary or mandibular structures may present a significant challenge: the forces associated with direct laryngoscopy for intubation could conceivably cause damage to incompletely healed bony structures. The duration and complexity of the face transplant operation requires participation of multiple teams, including more than one anesthesia team.
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